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Wednesday, May 11, 2011
Pregnant in the cath lab
There is potential harm in overstating the risk of x-ray in pregnancy. At least from my perspective. Sorry for additional post Fizzy, I have too much to say for comment section. I really think you are on to something here, and I appreciate this discussion.
First to get this out of the way, there is a major difference between therapeutic (or diagnostic) radiation exposure vs. occupational radiation exposure. All physicians would consider using x-rays to examine or treat a pregnant woman. As long as the benefit outweighs the risk. Do you need dental xrays while pregnant- probably not. You have a serious condition during pregnancy, attempts will be made to use alternative imaging or minimize fetal exposure. The risk to the fetus is based on amount of exposure (may vary based on type of exam) and week of pregnancy. It would be a mistake to x-ray a pregnant woman without considering the fetus (therefore the questions and signs in radiology). Just because there are signs and attempts made to avoid exposure in no way means that it is absolutely contraindicated.
Here as Mothers in Medicine we are discussing occupational exposure. A classic intersection of personal responsibility and professional obligation with undercurrents of gender discrimination. We would all take a bullet (literally) for our children, our own safety/sanity is only a secondary concern. What are we willing to expose our children to- now that is a hot topic.
Fifty percent of Internal Medicine residents are women, yet only 14% of all cardiology fellows and a mere 7% of practicing cardiologists are women. We may be few, but as women in cardiology we are a serious bunch- and are concerned about why more women do not consider careers in cardiology. It is likely women are deciding not to pursue cardiology early- as med students or interns. Concern over lifestyle and radiation exposure during mothering years is likely a key issue.
Tackling the subject head on, two important papers are published in cardiology journals. The first published in JACC in 1998 (http://www.ncbi.nlm.nih.gov/pubmed/9525565) is a consensus statement for radiation safety in the cath lab. This year another consensus statement (http://www.ncbi.nlm.nih.gov/pubmed/21061249 ) was published by a group of women interventional cardiologists (now these are women who I seriously admire). I recommend that you read both if this issue affects you directly.
Here are important points I would like to make:
1. Fizzy's initial post upset me a great deal, it felt like a personal attack (unreasonable I know). I think this points to how intimate and heart wrenching pregnancy related issues can be.
2. Fundamental radiation science: exposure is proportional to energy emitted, inverse to distance from source, and subtracted by protective equipment. When pregnant I wore two layers of lead (my usual apron) in my first trimester then special pregnancy apron (even though it weighed 12 lbs-or maybe a TON) the rest of the time. I never let the fellows control the fluoro pedal and when able always took an extra step away from the camera. On occasion I took it as an excuse to stay far far away from the table, on a stool in the corner where I could rest my feet too, a bonus.
3. When I was a fellow one of my female attendings was pregnant. It really helped me to see her in this role. She gave me the best advice. Meet with the University Radiation Officer- this really helped to balance my fears with what is known about the risk.
4. The female fellows in my current program are not allowed to work in the cath lab during pregnancy. This takes the decision making away from them. I am not 100% behind this, only because it is really hard for them to find coverage for maternity leave already.
5. X ray is not the only source of radiation exposure. I learned from the Radiation Officer that my greatest risk would be during my nuclear cardiology rotation. Patients dosed with isotope emit radiation, and despite high standards areas of radiation can be present in the department. Always wear your badge when reading nucs, do not leave your lunch in the reading room and for heaven sakes do not do injections for stress tests or PETs.
6. The total amount of radiation allowed in pregnancy is 0.5 mSv per month and 5 mSv for entire pregnancy. This is 10% of the amount of radiation defined as negligible by ACOG guidelines (Obstet Gynecol 2004;104:647–651 ). Studies from diagnostic radiology in pregnancy show exposure below 50 mSv is not associated with fetal loss or anomaly. Other population studies suggest that exposure to 100% of the allowed radiation during pregnancy will increase the risk of having a child with congenital anomaly from 4.0% to 4.01%. The chance your child will develop cancer will increase from 0.07% to 0.11%.
7. It is difficult for me to compartmentalize my role as mother and cardiologist. It all runs together in an overwhelming way. Eight weeks pregnant, while taking progesterone for a fetus at risk I was inches away from the camera while doing CPR on a woman while my partner inserted a temporary pacemaker. I had lead on, but had not yet declared my pregnancy and did not yet have a fetal badge. That woman celebrated Mother's Day with her children last weekend. During my 2nd trimester I was exposed to acute viral myocarditis, amazingly 3 times where two of the three patients were killed. Suspected viruses can cause fetal hydrops. The surviving patient was a miracle and my ability to cure him was instrumental. My team knew I had ID consultation and special tests by Employee Health. They did not know I took a "time out" in the call room where I sobbed uncontrollably for 20 minutes.
I carried two pregnancies and worked in the cath lab both times. I checked my fetal badge religiously every month. Under my lead, over 18 months of pregnancy my fetal badge (s) summed total radiation exposure of <0.01 mSv, below the measurable limit, ZERO.
It is probable that women avoid their true calling into cardiology due to concern over the occupational hazard. It is possible those who do pursue cardiology still face additional obstacles based on current maternity policies (I think this is true of most of medicine). My experiences thus far have been challenging, and I hope we can make things better for the next generation.
Okay so you may now jump in to discuss. So let me have it, I imagine being crucified and accused of child endangerment. For the sake of full disclosure in addition to exposing both of my boys to radiation I also ate lunch meat, non-pasteurized cheese and even drank a glass of wine (or two) during my 3rd trimester. And if anyone corrects my writing/ grammar I will kick your ass.
29 comments:
I am really glad that you wrote this post. I wanted to write more in my comment on Fizzy's post but ended up cutting a lot out. You said pretty much everything I wanted to say. I am certainly not going to crucify you, JC. You did your research, assessed the risk and made a decision that worked for you.ReplyDelete
I read an article a while back that said that more than 50% of pregnant women are seriously worried that something is wrong with their baby, which comes across to me as very sad. My hope would be that pregnancy is a joyful time, not one full of stress, fear and anxiety.
- Dr. KatieMay 11, 2011 at 10:31 AM
Thank you for this. I am glad you have provided this perspective for all the young women out there looking to go into cardiology or any other field who also want families. I have of late been concerned about the amount of negativity about med school, residency and pregnancy during these times I see coming through on this blog. This negativity is mainly in Fizzy's posts.ReplyDelete
I think this blog should be realistic, but at the same time should convey a sense of optimism and possibility for women as they embark on their careers. I had a good experience being pregnant in medical school and then again 3rd year residency and I want women to know that it IS possible.
- AnonymousMay 11, 2011 at 10:56 AM
Thanks for the well-written, informative post. I will say, though, that the thought of radiation never crossed my mind when deciding not to do cardiology. (I'm a general internist 2 years out of residency.) Maybe lifestyle played into my thinking, but more likely it was the 6 months of cards/CCU time in residency that turned me away.ReplyDelete
- AnonymousMay 11, 2011 at 11:10 AM
I spent the summer between M1 and M2 with an ID doc who saw very sick HIV patients at a free clinic. I was also 14-22 weeks pregnant at the time. I spent the summer mildly terrified I would contract a virus or infection from them that wouldn't normally be prolific in a patient population (but is due to their HIV status). My ID doc was somewhat protective - I did not see patients who were incredibly ill and had known counts below 50. I was still terrified, because as a rising M2 - I just didn't know what I didn't know, and everything scared me.ReplyDelete
Thank you for your post - I think it cross specialties...I couldn't help but wonder how this would work if I were an ID doc and encountered extremely ill, full-blown AIDS patients with possibly transmissable viruses to my next unborn.
I do wonder how it would work if you got a needlestick injury while doing a procedure on a patient with HIV and a high viral load. Anybody know? I'm assuming you'd still get post exposure prophylaxis....ReplyDelete
- sunnidayMay 11, 2011 at 11:24 AM
Nope,no accusations from me. Like any reasonable woman committed to her career in medicine, you balanced risk with the responsibilities and did your best. Brava.ReplyDelete
I worry about discouraging women from doing specialties because "they will be hard in motherhood." Doesn't this create a prejudice of low expectations and perpetuate myths about ability? I think that if you love what you do, you will do that job better and other aspects of your life will benefit from your fulfillment. If cardiology is what floats your boat, do it. Will you have to make adjustments and compromises, absolutely. but I think it would be harder to justify the time committments, stress etc of a field if you did not enjoy the day to day. Your actual period of childbearing will be overall short compared to the length of your career(demands of motherhood are another question entirely). What is helpful is creating a community of support: attendings, fellow residents, etc to provide guidance and help when you need it. Helping each other out is critical.
Let you have it? I think it was an awesome post.ReplyDelete
I think it is important to balance conveying optimism about being a MiM with not sugarcoating the undeniable hardship that it is. It is important to not minimize that there is a significant amount of anxiety & stress involved for many of us. If none of that ever bothered the OP, hats off to you, but we're not all like that.ReplyDelete
Personally, I came within inches of quitting my residency when my daughter was 11 months old and STILL waking me up every two hours. Am I eternally grateful that I didn't, now that I enjoy the good life as an attending? Yes. But that doesn't mean it never happened and it is ok to talk about it and get some support from sympathetic others.
Oh, and concerning radiation: I worked with it every day during my pregnancy, and did lots of cardiac injections. My dosimeter never showed above background. I am pretty sure that the reason for that is because I knew exactly what I was doing, how radiation works, and how you minimize absorbed dose to your body.
Still, I understand that if you're on a rotaition during your pregnancy and don't routinely work with radiation, it causes major anxiety to pregnant women. I would always respect that. I think there is nothing to it to help out, even if I do think it is not based on concrete risk, but on irrational fear. Who cares? It's hard enough to be pregant IMO, so I'll go easy on the colleagues who are.
I got a non-hollow needle poke from a Hep-C positive man with unknown HIV status. I finished the case in record time and pagIng both HIV specialist and my OB, I decided to take the prophylaxis. Thankfully the pt was neg for HIV and I did not contract hepititus.ReplyDelete
Radiation exposure (I'm an orthopedic fracture surgeon) and exposure to blood and tissue did not enter my mind when choosing a specialty. I admit, it enters my mind now when I see my beautiful, healthy son.
JC: I'm sorry you took that initial post as a personal attack (b/c of the radiation part? not sure). The reason I made the second post was because I felt like none of this is a clear-cut issue and I was curious what other people thought. I talked to my own father about it and he said to me, "Well, I'm sure it would have been OK, it's so little radiation." Like you said, pregnancy is emotional... I once started crying because I forgot and ate some cold cuts. I mean, how crazy is that? (And also, a colleague told me that I was putting my baby in danger by wearing my pager on my belt.)ReplyDelete
I very much doubt that having stepped in for that X-ray would have put my baby in any danger. I guess it just seemed so simple/fast/easy for the attending to step in to help me and was kind of miffed that she refused. I think I said in my second post that the only thing they were able to prove for sure is that radiation is a source of anxiety for pregnant women. And we're already exhausted, stressed, lots of hormones, etc.
Personally, I'm not a big fan of radiation exposure in general, even with protection. After my pregnancy, I was always willing to go into the fluoro lab during residency, but I was nervous about making it into a career. But that still, I think, makes me less neurotic than my mother, who will not speak to me if I'm on my cell phone.
- Dr.NanaMay 11, 2011 at 1:47 PM
The conversation between fizzy and JC is important not just because of the radiation question, but because of risks in medicine in general. And then, when pregnant, we all tend to worry a little bit too much.ReplyDelete
I was doing ID at a university hospital during my pregnancies - the SBE and post-op unusual infections are fine - but we also dealt with the famous swine flu epidemic at that time and the first cases of Legionella. If you have seen any historical pictures, we looked like the alien squad from the movie ET. Then there was acute/febrile generalized CMV, unexpected in a healthy 50 year old. And the pregnant varicella pneumonia patient who almost died and caused me a few minutes panic until I realized - I had the disease at age 7 or 8, I'm immune.
During my residency in a large city hospital, one male surgery resident was stabbed almost fatally by a patient and after I left a female pathologist there was killed by strangling.
So, in any of the specialties, we have to be aware of the risks, and try to be knowledgeable about the relative risk and actual absolute risk and preventive measures. But I'm afraid that once pregnant physicians start to ask too frequently for special accommodations, we'll find that some of the best training programs and some of the best jobs will be off limits. Overt discrimination will not be tolerated of course, but there will always be some other reason not to accept a potentially pregnant candidate for the position.
JC, I really appreciate your post, specifically the research. I found out I was pregnant just before starting a vascular rotation. I had planned to spend a significant amount of time in the interventional suite since I have an interest in vascular surgery, but instead elected not to. I went to my GME office, the occupational health office, the hospital safety officer, pub med, OR nurses and the interventional radiology department to try to find out information/protocols about protecting myself from radiation exposure. No one could answer my questions. My OB just told me to try and minimize exposure and no one at the hospital seemed to know how to get me a fetal badge. Finally, someone suggested talking to someone in the cardiology department, but by that time I had given up and was soon heading to the lab. The experience turned me off a little to vascular surgery as a possible career because I couldn't find a way to quantify this risk (and we have no female vascular surgeons at my institution). Thank you for helping shed some light on this.ReplyDelete
I think the fear would be significant lower if there were better protocols established for health professionals in this situation. When I started in the lab, I was assigned a safety officer who came to assess my workplace and gave me a personalized detailed plan to minimize radiation and chemical exposures. Because of this I was able to comfortably do my job without unnecessary fear.
- CardioMomMay 11, 2011 at 6:14 PM
JC: excellent article, very objective and based on good and proven scientific evidence. I worked 12-14 hr long days in the cath lab for almost all of my pregnancy and even though my instituition had not followed the standard policy in place to protect the unborn fetus,(now my beautiful healthy son); once I presented the evidence to them (from the NRC published guidelines in place) they gladly adopted it. Fizzy's post made no contribution to educate members on more important issues that face us in medicine (like advocating for the enforcement of afore mentioned guidelines), instead her post clouded the issue of radiation with emotional decisions made during her training( its her perogative to do so though, but by no means a way to look at medical training). Women are maligned enough in medicine as it is, to introduce a concept that we need protection from all variables while pregnant will do nothing to advance our individual or collective career goals and objectives nor allow us to be treated as equals with men in medicine. There are a lot of potential risks to doctors wether it is in blood draws, attacks from patients, viral illnesses or occupational risks to us or to our ability to procreate that if we focused on, we would be completely paralysed and unable to end up in ANY specialty (and this is irrespective of sex). Just as our soldiers and cops accept a level of risk that comes with their jobs, the very call to practice medicine involves risks, to ourselves, families and careers...thankfully most of us go on to have long, bright and succesful careers, while mothering bright, healthy and successful children.ReplyDelete
Again thanks JC for putting this issue in perspective and avoiding the hype
I can't imagine why anyone would criticize this piece. A fantastic, level-headed, evidence- and experience-based post. One of the best things I've read on MiM in a while!!ReplyDelete
Ladies do not be too hard on Fizzy. I love reading her posts and occasional feisty commentary. I feel like we achieved a real moment here, this would not have been possible without her courage to share her feelings and recollections from pregnancy.ReplyDelete
Thank you all for the support and encouragement- while I am on a high let me share one more thing:
My levelheadedness about this issue evolved. True to Darwin my CPR close to the camera without a fetal badge shocked the ecosystem, so to say. At the time I was conflicted over disclosing my pregnancy- with potential for miscarriage. With new clarity the next morning I submitted my fetal declaration form and boldly moved forward.
I hope we remember that it is okay to not have it all figured out. It is also okay to make a misstep, or swing wildly from the left then the right of your favored middle place. I imagine certain truths come naturally to some, and others require a little more... let's say evidence. And I am not talking about radiation anymore.
Cardiomom: You're right... the purpose of my second post was NOT to educate, because radiation and pregnancy is not something I know a lot about. I was simply sharing an experience I had and how it made me feel. Believe it or not, I don't do a pubmed search prior to my posts. I was trying to elicit opinions from others, which is why my entire last paragraph was questions to the readers. I don't claim to know a lot about the topic and it's not something I looked into much, since my own exposure was so minimal. I sincerely appreciate JC, who clearly does know a lot about the topic, taking the time to educate us.ReplyDelete
I can say that pregnancy is an emotional time for most women and I don't think it's unreasonable to avoid certain things, if possible, that are going to drive you crazy with worry. I didn't advocate that my pain specialist friend quit her job while pregnant. But if it's a matter of a single (and pointless) exposure to something that's going to make you anxious, why not avoid it?
And I'm sorry that some people feel that I only share negative experiences about medicine. First, it's not entirely true... although people seem to take more notice of the negative posts. Second, a lot of people do have negative experiences during their training. It's a fact. A childhood friend of mine made a suicide attempt during internship and that's something I will never be able to forget. Honestly, aside from internship, I don't think my training was even that bad (I actually enjoyed a lot of it and had some wonderful attendings and colleagues, for the most part), but I write about the bad things that happen so that people having a hard time can relate. I wish I realized that other people were unhappy when I was an intern, instead of only finding out about it much later. I felt very alone at the time.
What Tempeh said. Great post.ReplyDelete
- AnonymousMay 12, 2011 at 12:41 PM
Kind of sad, that CardioMom denies hard working pregnant physicians their right for sympathy. I view this blog as support, and reflection on our incredible journeys in motherhood and medicine.I have little doubt that cardimom and many in general public would have much more sympathy for stay at home mom's blog site where moms would complain about boredom, routine or super-diffiuclt tasks they manage at home, and yet are so deprived of more challenging (work) experiences. Guess what most of us manage all that AND our work. Yet phsycian woman have no right to be weak, emotional, struggling, doubting, or they will be blamed for being unfit for profession (you knew what you were getting into !). Fizzy's posts helped me personally to realize I was not alone in my training, but I did feel isolated like her, mostly afraid to ever admit to anybody it was very diffuclt to work full time while newborn was awake every 2 hours. Fizzy's post is a reflection on the past, and it helps some of us to affirm and validate our exepriences too."Advocating for guidelines" will not happen if many women doctors feel its OK to work 120 h/week, radiate yourself, have your waters break at work, ask for help, etc. My fellow trainnee for instance passed out while pregnant doing rounds. Trust me, CardioMom, our cops and troups have more protection/med coverage/disability benefits than any of us will ever dream of. They give service to society but society protects them in need.ReplyDelete
Excellent post, JC. I didn't consider cardiology either, but radiation exposure did not factor into the equation for me. It was more of a personal preference.ReplyDelete
In my own specialty, I didn't have to worry about the hazards of radiation, but I did worry about infection exposure. I stayed out of the room when the brain saw was going during autopsies and let organs from HIV and Hep C patients fix in formalin according to the guidelines of my most conservative attending, who lost a neuropathology mentor to HIV/AIDS that he contracted from a brain during autopsy.
I also turfed fetal autopsies - largely for emotional reasons, which I think are important to respond and attend to, as much as I encourage science-based decision making. My male and female colleagues were more than happy to trade more complex surgical specimens, such as whipples, for them, and I didn't have to eviscerate organs from pre-term IUFD babies and compare them to my own unborn children, something for which I am eternally grateful.
I feel a need to make another comment here, since I'm getting kind of trolled on my last post. Unfortunately, a lot of the comments here got deleted.ReplyDelete
JC: I actually had no clue how much radiation cardiologists got exposed to until I read your post. Probably the biggest reason most women I know shied away from cards is because of the lifestyle. After all, there are a lot of female radiologists.
I also think it is great that JC provided research about radiation exposure during pregnancy, but at the same time, it bothers me that some people seem to be contorting her words to say that women who want to avoid radiation during pregnancy are "irrational and overly emotional." I think it is very "rational" to want to avoid something that your doctor and society as a whole tells you to avoid. Is it *correct*? Well, that's a whole different argument. In the future, maybe there will be a definitive study and we won't have checkboxes on X-ray forms for pregnancy. But right now, as physicians, we all know that there's a hesitation we have in sending pregnant patients for X-rays, etc. Until that changes, pregnant women do have a "rational" reason for wanting to avoid radiation.
JC looked up the data and made the decision that she didn't want to miss out on an important part of her training by avoiding radiation. I totally respect that decision. But at the same time, I think we should also respect the decision of pregnant women who want to try to minimize their exposure to radiation, especially in the case where it's rare exposures that add absolutely nothing to the educational process. In my case, it wasn't as if I wanted to get out of a rotation or even one clinic--it was 10 minutes of scutwork that would have taught me nothing.
- AnonymousMay 14, 2011 at 12:10 AM
It is not wrong to ask for help when you are pregnant. But why would it be a low expectation if if you hear about hardships of certain specialties. Isn't being a doctor a great achievement already? Some women are fantastic and want to be on the front lines in OR, those who can really handle it would not abandon their dreams.But women in doubt should know being a family practice physician does not make them loosers.ReplyDelete
- cellofellowMay 15, 2011 at 10:20 AM
Thanks for the post. As someone who recently waded through the decision of which medical/surgical career to pursue, I wouldn't agree that radiation exposure plays into the decision of whether or not to pursue cardiology. Lifestyle, sure, but for so many students or residents, it's just not what piques our interest. And for some, an internal medicine residency isn't a prerequisite worth enduring (a lot of call, difficult inpatients, etc.). I feel fortunate that the specialty I chose excites me the most intellectually, but is also reasonable for those with families.ReplyDelete
- sunnidayMay 16, 2011 at 8:52 AM
Anon@ 12:10-What I meant about low expectations is that we want to be able to do the specialties we choese. If there is a stigma associated with pregnancy in the minds of people chosing candidates for specialities, then women "might" become limited in what they get chosen to do. They have every right to choose which ever specialty but I would shy away from language indicating that women should avoid "tough" specialties because it will be hard during pregnancy. Choose what stimulates you, what fits your personality, what works for your life circumstance and then adjust what you need to do if you get pregnant. That is why I love JC's blog. She did what she had to do after she assessed the risks. Was it easy? of course not.ReplyDelete
We have had many blogs here about loving what you do. If I did not love what I did in my niche, I would not be able to justify the time away from my kids. If I had chosen something else for the lifestyle, I do not know if I would have been so content. I would not want those choices taken away from me because they are "hard."
- AnonymousMay 17, 2011 at 11:34 PM
thanks for the Great post. I'm a doc, and pregnant with my third, and had two hot dogs for dinner.ReplyDelete
- CNM KatieMay 20, 2011 at 5:33 PM
Hi JC, I just wanted to applaud you for the hard work you put in as a pregnant cards fellow. My husband is a cardiology fellow and told me about one of his colleagues, who will in fact be one of those crazy interventional people, double-leading through her pregnancy. It reminds me of Ginger Rogers doing everything Fred Astaire did, except backwards and in high heels. Good for you :)ReplyDelete
- AnonymousJune 13, 2011 at 4:01 PM
As a woman and a cardiology fellow, I'd like to weigh in.ReplyDelete
In my program, decision taking is also taken away from the women. Pregant women, nurses, techs and fellows alike (there are no female attendings) are immediately banned from the lab. I personally do not support this policy. I looked up the data and felt safe.
So when I became pregnant some time ago, I decided to wait a couple of weeks before declaring my pregnancy. I told no-one about the pregnancy and kept on cathing.
My pregnancy progressed well, and at 7 weeks I was finally able to detect a heartbeat with te TTE machine. That stolen moment of pure joy as I sat in the empty echo lab all by myself looking at that tiny flicker is forever etched into my memory.
36 hours later I miscarried.
My rational mind keeps telling me that this miscarriage has nothing to do with my decision to stay in the lab, and everything with a chromosomal abnormality in the embryo. My husband, who is an engineer, keeps telling me that I have had less exposure standing in the cathlab wearing lead, than standing outside without it.
And still I don't know whether I'll keep cathing during my next pregnancy. Rationally: yes. Emotionally: don't know yet.
But I still feel the decision should be MINE and no-one else's. Women in cardiology face enough discrimination as it is.
Dear Anon (6/13/11)ReplyDelete
For me, two pregnancies total fetal badge radiation= zero.
I miscarried my first pregnancy too. It was devastating. It was supposed to be the "ideal" time. I was in a basic science lab as a post doc.
What you are going through is so hard. Whatever you decide regarding the cath lab will be right. Value what you personally/ emotionally need.
- AnonymousApril 26, 2012 at 3:17 PM
Thank you for posting this!. I am an interventional cardiologist and just found out that I am pregnant. I plan to continue working in the lab but will admit I am cutting back from 4-5 days per week to 1-2 days per week. Your post has reassured me that if I am careful and keep on top of my radiation badge readings I should be ok. Thanks again!
I was wondering what everyone's opinion was. I recently found out I'm pregnant (only about 3-4 weeks). I am a cardiology fellow and still have 2 days of cath left next week and then another month this year. I am hesitant to disclose my pregnancy to the department yet. It's just so early. But also don't want to do anything that will harm my child. Sounds like the amount of radiation I'm exposed to is minimal. Do you think it's safe to at least finish off this month? (just 2 more days) Thanks!


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Hello all couples, my name is Kounouz and I am in a relationship. I'm 39 years old and my guy is 35 years old. We're on this libertine site because we're hot. We are free at the weekend to meet and have fun. We would prefer to give you a meeting in a public place if that is okay with you. We've been fans of libertine dating for a while now. My guy and I bring up new dirty practices from time to time, right now it's swinging. We would prefer a man or couple without taboo for this libertine appointment because we want to send ourselves in the air as much as possible !!! Mr. will have to be strong, sorry but it's my whim at the moment. In short, we will read your proposals for this sex meeting. We hope to see you on Shreveport! Kisses!
A date in a public park for young woman who enjoys exhibitionism Smyrna
Doona Bae Feet
First name: Lisemay, Age: 22 yo, City: Smyrna (TN)
Hi everyone, my name is Lisemay and I'm 22 years old. I live in Smyrna. I'm rather glamorous, naughty and erotic. Can we schedule a time to meet at your place for this hookup? I am also free during the day and on Sundays. Ideally, I would like the gentlemen who write to me to be brown and quite muscular. After that, the man I'm looking for must be persistent because I ask for a lot sexually. I can stay in bed all day if my partner knows what they're doing. A hot date should make me have an orgasm. I want a man who is good with his tongue. I'm also addicted to anal sex, but in a tactful way. I'm not against a date in the woods if you're up for it. I'm attracted to a lover who wants to dominate during our sexy encounter. I'm only here to enjoy myself. So, I'm asking you to contact me right away if you want to take me in every way. I need a kinky guy who's perverse enough. Kiss.
A nice couple from Palo Alto would like to try out swinging
Doona Bae Feet
First name: Jeannique, Age: 48 yo, City: Palo Alto (CA)
Hello, we are a naughty couple and we're on Palo Alto. My name is Jeannique and I am 48 years old. My boyfriend is 53 years old. I prefer men who are tbm and very muscular, but don't worry it's just a desire. However, I am waiting for a good fucker like my bichon. I want to moan. We almost everything in libertinism and that of course with respect and hygiene. However, we prefer candaulism with a trained couple. We would like to arrange a meeting with you in the woods. We are also available on weekends. To meet us, just leave a message. We just want to fuck between kinky people.
A couple who enjoys sharing their partner with others for a day of outdoor sex in the city
Doona Bae Feet
First name: Fouzilla, Age: 49 yo, City: Tinley Park (IL)
Hello guys, my name is Fouzilla and I just turned 49. I am in a relationship and we are very open-minded. We really enjoy going to swingers clubs in Tinley Park to meet open-minded people. I'm a little bit to blame because I'm naughty with men and I have no taboos. We are available at the weekend in order to see each other and spend time together. We would prefer to give you a meeting in a public place if that is okay with you. We would prefer a guy or couple without any taboo for this fuck because we want to get laid as much as possible!!! The man will preferably be tall, sorry but it's my whim right now. Now we want to see your hottest proposals. I hope to read your comments. Kisses! See you soon.
I'm a nymphomaniac woman looking for a one night stand
Doona Bae Feet
First name: Laurianna, Age: 18 yo, City: Southfield (MI)
I am inexperienced for libertine games like swingers or others. I want to try these things with a guy who is an expert. I'm usually available during the day. I can move around easily in Southfield and its surroundings. I don't care whether it's at your place or not, as long as the location is clean. Since I'm new to swinging, I want a partner who knows what they're doing. I want to be taken care of and be your object during this fuck so that you can play with me and reach the maximum amount of pleasure. So if you want to meet me, let me know. I hope I was clear and that you will be able to meet my needs.
A couple amateur of threesome would like to take pleasure in an adult club on Rochester Hills
Doona Bae Feet
First name: Laetitia, Age: 36 yo, City: Rochester Hills (MI)
We just want to have fun with you. We post on this libertine dating site because we enjoy playing with other men during sex sessions. We are free this weekend for a libertine rendezvous in Rochester Hills. We would like to invite you to a swingers club. We've been playing naughty games for a few years now. We're trying out new experiences between libertines sometimes, these days it's exhibitionism. So, we're waiting for your proposals for this sex meeting. I hope to meet you in Rochester Hills! I kiss you!
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5700W Solar Grid Tie System - 30 Sanyo 190W, 6000W SMA Inverter
The Sanyo 5700W Residential Solar Grid-Tie Systems (SGTS) provide reliable power for your home using top quality UL listed products. Each grid tie system is pre-packaged to save design time and includes solar modules, mounting systems, inverters, cables and all necessary hardware and electrical components. The 5700Wresidential / business solar grid-tie system is modular which means you can combine multiple units together or add to your system in the future.
The Sanyo 5700W solar grid-tie system meet NEC code requirements and US safety standards. The mounts, optional, securely attach the array to the roof in compliance with US Building Codes. Complete installation guide and operational manual included. An optional utility grade kWh meter is also available. Each Sanyo 5700W solar grid-tie system comes with a 20 year warranty on power output and a five-year system warranty.
The 5700W solar grid-tie system employ UL listed Sanyo solar modules – ideal for grid-tie applications. Sanyo modules have one of the highest Performance Test Condition ratings per watt (W ptc) for higher rebates in California. Performance Test Condition testing simulates the real world, high cell temperatures modules are subjected to in the field.
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Also Known As:


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ACTIVE - Find & Register for Races, Local Events .
ACTIVE is the leader in online event registrations from 5k running races and marathons to softball leagues and local events. ACTIVE also makes it easy to learn and prepare for all the things you love to do with expert resources, training plans and fitness calculators.GET PRICE >>


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Qibla Direction in Tiaret - Algeria
Before you know the qibla direction in your city we have to be honest with you because the prayer/salat in any muslim's life is a very serious and important thing ... it is the cornerstone of islamic religion. So, we can't underestimate the qibla direction determination like as most of other islamic applications and websites do. Especially that any programming code might give you incorrect results .. because at the end who wrote this code is a human like as you and me, and as we all know ( perfection is only for Allah/God ).
The method we are using to determine the qibla direction for Tiaret is a purely programmatic/automated method, and we always advise you to make the priority in knowing the direction of qibla by asking the trustworthy muslims who live in Tiaret .. but if you don't find someone then, you can use the normal compass .. but you have to have some few knowledge about world map and ( north,south,west and east ) directions and the location of KAABA or Al-Masjid al-Haram ( Great Mosque of Mecca ) on the world map, and no doubt this is the second best method you can use to know the qibla direction in your city.
but just in case you are compelled to do that for any reason or you don't have compass, We can guarantee to give you an accurate Qibla direction in Tiaret and in most cities of the world by more than 95% accurate ratio.We are very sorry for this long introduction, but we had have to be honest and clear to please Allah/God and because we know the prayer importance in any muslim's life


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On Friday evening, Motorola Mobility, a Google subsidiary since May of this year, filed a patent infringement suit against Apple with the International Trade Commission. It said Apple had infringed on 7 of its patents in creating the iPhone, the iPad, and the iPod Touch, and Motorola is seeking an import ban on those products to the US.
While the paperwork filed by Motorola with the ITC was not immediately available, WSJ is reporting that none of the patents Motorola is asserting are currently considered standards-essential, meaning Motorola may have a fair chance at getting its requested import ban if the ITC decides Apple has in fact infringed. Patents that are not standards-essential may be licensed or not licensed at the holding company's will, whereas patents that qualify as standards-essential require holding companies to license them at fair, reasonable, and non-discriminatory (FRAND) prices. While judicial authorities have been called upon to decide what constitutes a FRAND patent, there is no legal precedent that defines what fair, reasonable, and non-discriminatory means in every case.
"We would like to settle these patent matters, but Apple's unwillingness to work out a license leaves us little choice but to defend ourselves and our engineers' innovations," Motorola Mobility said in an e-mailed statement to Bloomberg. The publication also noted that in a previous patent battle with Apple, the Cupertino company said that Motorola's demands for licensing fees are unreasonable.
In that previous patent dispute, the ITC ruled in April that Apple had infringed on one of the four patents asserted by Motorola against Apple. The ITC will make a final decision next week on what, if any, consequences Apple may suffer for that infringement. But even if Apple comes out on top next week, it will still have to look forward to the new suit—yet another locking of horns at the ITC.


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Color Options from American Patchwork & Quilting February 2010
Courtyard Garden
Border upon border provides structure for the central garden of appliqué in this medallion-style throw.
Courtyard Garden Color Option
Blossoms and Borders
With wispy blossoms similar to Courtyard Garden's floral appliqué, the Arabesque collection by Sue Zipkin for Clothworks was a natural choice for quilt tester Laura Boehnke's version. To save time on cutting and appliqué, she used four borders instead of eight.
Sew Scrappy
Fifteen fat quarters, simple strip piecing, and careful pressing make this throw a snap to complete. Pieced segments left over from the quilt center enliven the border.
Sew Scrappy Color Option
Four-Pointed Star Chain
Go country with muted, small-scale prints from the Folk Art Favorites collection by The Buggy Barn for Henry Glass & Co. Quilt tester Laura Boehnke created an Irish Chain effect with careful placement of the squares in the five star and four 25-Patch blocks. A two-color checkerboard border provides a neat frame to the table topper.
Tiny Dishes
Set miniature Broken Dishes blocks inside an asymmetrical frame for a contemporary setting of a traditional block.
Tiny Dishes Color Option
Broken Dishes Table Runner
When making miniature quilts, quilt tester Laura Boehnke suggests using small-scale prints. "Calicos from the Crimson and Clover collection by Jo Morton for Andover Fabrics are perfect for little blocks like the ones in Tiny Dishes," Laura says. She used just two prints in each Broken Dishes block.
Red Hots
Flying Geese and hourglass units in 24 red hues ranging from tomato to burgundy pair with 16 light prints for an ultrascrappy take on the classic two-color quilt.
Red Hots Color Option
Scrappy Table Runner
For her traditional table runner, quilt tester Laura Boehnke incorporated five colors into her still-scrappy version. To frame her three quilt blocks, Laura decreased the border from 6-1/2" to 4-3/4" wide. The multicolor palette creates an all-purpose runner to decorate the table throughout the year. Fabrics are from the Blessings collection by Brannock & Patek for Moda Fabrics.
Band Together
Whether improvisationally pieced or carefully planned, strip sets make it easy to piece rectangular blocks in myriad shades of blue.
Band Together Color Option
Fussy-Cut Baby Quilt
Take Band Together from bed to baby crib by showcasing cute-as-can-be animal motifs in the setting rectangles. "This simple pattern is ideal for fussy cutting," says quilt tester Laura Boehnke, who used fabrics from the Nana's Garden collection by Arlene Neely of Rabbits Haven for Red Rooster Fabrics. Laura arranged four bunny print setting rectangles in the center of her quilt and cut the rest of the setting rectangles from a small floral.
Love to Quilt Project Tote
The perfect tote for the passionate quilter, this bag is roomy enough to carry all your quilting supplies. An appliquéd block forms a pocket for additional storage.
Love to Quilt Project Tote Color Option
Heart Appliqué Wall Hanging
Swap out cotton for felted wool and cozy flannel to make a wall hanging that warms the heart. Quilt tester Laura Boehnke cut appliqué shapes from jewel-tone scraps of felted wool. For the foundation and border, she used houndstooth and plaids from the Woolies Flannel collection by Bonnie Sullivan for Maywood Studio.
Skylight Stars
Soft brown prints provide the structure for this scrappy quilt, neatly framing the Pinwheel units and clearly defining the Starry Lane blocks.
Skylight Stars Color Option
Starry Lane Wall Hanging
Brown not bold enough for you? Throw a lively fiesta by swapping the dark hue for multicolor florals as quilt tester Laura Boehnke did to create a festive framework for her Starry Lane blocks. Fanciful orange, red, and yellow prints from Julie Paschki's Folklorica collection for In the Beginning Fabrics make the Pinwheels and star points pop like colorful confetti against the black background of this nine-block version.
Not Quite Cubes
Bold colors and prints bring this quilt to life. At first glance the geometric shapes appear to be Tumbling Blocks cubes. But they're not!
Not Quite Cubes Color Option
Black, White and Bright Throw
For a condensed version of Not Quite Cubes that packs a juicy punch, quilt tester Laura Boehnke pieced citrus-color and black-and-white prints from the Luna collection by Gail Fountain for Maywood Studio. The three colors alternate with the black-and-white prints in a single row of six blocks. To adapt the border for her smaller quilt center, Laura cut 4x44-3/4" and 2-1/2x33-1/4" stripe inner borders.
Sweet Tea
The secret to creating this field of stars is not in the blocks, but in the sashing.
Sweet Tea Color Option
Patriotic Prairie Points
Quilt tester Laura Boehnke selected prints feature stars and stripes from the American Patriot collection by Faye Burgos for Marcus Fabrics for her version of Sweet Tea.
For this smaller version, Laura needed 14 prairie points, instead of 23, for each side.
Blossoms in the Breeze
Create a colorful combination of twirling Windmill and eye-popping flower blocks with the greatest of ease using strip piecing and fusible appliqué.
Blossoms in the Breeze Color Option
Windmills and Flowers Wall Hanging
Quilt tester Laura Boehnke experimented with an array of prints from the Wild Thyme and Pop Parade 2 collections by Carolyn Gavin for P&B Textiles in her version.
"I used one multicolor and two tone-on-tone prints in my strip sets to make the Windmill motifs pop when I assembled my blocks," she says.
Laura blanket-stitched around each appliqué shape to give her version handmade appeal.


text: All Lokar Hi-Tech Throttle Cables are available in either stainless steel braided housing or black housing. They are designed with a specially extruded liner for extended life of the cable - not to be confused with ordinary braided brake hose. Cables are equipped with aluminum fittings and aluminum ferrules to eliminate fraying. ''U-Cut-to-Fit'' outer housing is available in a 36'' length with a ''U-Cut-to-Fit'' stainless inner wire. Clevis is designed without cotter pins or set screws. Adapts to factory and aftermarket pedals. Cables mount nicely with Lokar's array of Brackets and Return Springs (sold separately). Kits complete with installation instructions.


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Users are complaining of nausea caused by parallax effects and zooming animations in iOS7.
It turns out that not everyone is a fan of the first Jony Ive-designed iPhone and iPad operating system. Despite widespread praise from the tech and user interface design community, a number of iPhone owners have been taking to Apple's Support Communities notice board to complain that the new system — which includes brightly colored 'flat' icons, overlaying 3D effects and prodigious use of fast zooms in and out when opening and closing folders or apps — is making people feel sick.
The thread on the community board, started with a posting from Ensorceled on Sept. 18, the day the new software became available for download, which read: "The zoom animations everywhere on the new iOS 7 are literally making me nauseous and giving me a headache. It's exactly how I used to get car sick if I tried to read in the car. How do I turn them off? Do I have to revert to [iOS] 6?" now runs to over 12 pages of similar complaints plus other users' helps and hints for minimizing the effects the software is having.
In newer iPhones – the 4S onwards, there is a 'reduce motion' option in the control settings but the feature is missing from iPhone 4 handsets. However, the animated wallpaper and lock screen can be replaced by static images on all compatible devices.
Users on the thread that have talked to Apple said that there was no way of disabling the functions completely and worse still is the fact that anyone who has upgraded to iOS7 is now locked in. Apple has removed the ability to downgrade back to iOS6.
For now, the only solution for those that are feeling dizzy with the side effects of the upgrade is to email Apple's developers and request that they build in a 'turn animation off' option into a future iOS7 update.


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Diane O'Meara's photos were used without her knowledge to portray the girlfriend of Notre Dame football player Manti Te'o. Anderson Cooper spoke with O'Meara about the hoax and the contact she had with the man accused of creating the fake Lennay Kekua persona.
Post by: Anderson Cooper
Filed under: 360° Radar
As pretty and well-spoken as she is, she'll probably get job offers for the news and such from everywhere. They might have done her a big favor. Scary that it could happen, though.
Diane O'Meara and Te'o should press charges against the "mastermind" for stealing her identity and ruining his football career- he intended to harm them both with this hoax. Only by doing so will the whole truth come out. If the "mastermind" was sent to jail maybe all the other idiots who do similar sadistic hoax would think twice.
If Manti Te'o talked to this fake girlfriend on the phone for hours and hours and hours. Who was he talking too?
I agree. It still doesn't make much sense.
Anderson Cooper goes beyond the headlines to tell stories from many points of view, so you can make up your own mind about the news. Tune in weeknights at 8 and 10 ET on CNN.
Questions or comments? Send an email
Want to know more? Go behind the scenes with AC361°


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Getting Around
Info - Missionary PrayerGuard
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Praying for:
Ghulfan, Arabized of Sudan
Topic: 1 of 3
Miracles: Confirming the Word
Words have little meaning, especially in places where physical needs are great. It takes the miraculous to capture the hearts of the people. In places where embracing Christianity means abuse and persecution, believers need to be sure they have accepted the real God.
Ask for miracles to confirm the truth of the Gospel, that deceptions would be shattered, and believers would be strong in their faith.
Ac 6:8 Now Stephen, a man full of God's grace and power, did great wonders and miraculous signs among the people.
God, I proclaim that You are righteous in all Your ways and kind in all Your deeds. You set captives free, make the lame walk, and raise the dead. I ask for Your mighty power to be demonstrated.
Just as You did for Stephen, fill
Ghulfan, Arabized of Sudan
with Your grace and power. Release great wonders and miraculous signs among those he ministers to. Reveal Yourself, Father, that all may know You and have eternal life. I ask for a double portion of faith over
Ghulfan, Arabized of Sudan
and for the grace he needs to step out and believe You for mighty things. Bless his work today with a demonstration of your power.
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Ever since it was announced, I've had skepticism about the purpose and value of Windows RT, Microsoft's version of Windows that runs on ARM computers. The upside of Windows RT—cheap devices and long battery life—was diluted by Intel finally managing to beat its Atom processor into shape. The downside—incompatibility with almost every Windows application ever written—seemed substantial.
I'm not alone in this skepticism. Acer decided not to ship a Windows RT product, preferring instead to gauge the market reaction (though the company may be softening its stance and might ship a Windows RT tablet later in the year, if it believes that Microsoft has made the operating system sufficiently appealing to consumers). Around the time of CES, Samsung said that it wasn't going to ship its Windows RT device, the Ativ Tab, in the US due to lack of retailer interest. The news has gotten worse: the company is now not going to sell it in Germany as a result of weak demand.
Windows RT is an odd mix of features. Under the hood, it's a near complete copy of Windows 8. In spite of having all the working parts of Windows 8, however, it can't (officially) be used to run desktop applications, even if the developers of those applications are willing to recompile for the ARM processor. Instead, all applications must come through the Windows Store, and be built using the WinRT API.
It does, however, support a handful of built-in desktop applications. Specifically, Word, Excel, PowerPoint, and OneNote are all included. These versions are almost, but not quite, exact equivalents to their x86 counterparts. They are, however, lacking extensibility. There's no macro support, no add-in support. Screen recording in PowerPoint and OneNote is removed, so too is the ability to search audio and video recordings in OneNote.
Many of these missing features won't be noticed, but the lack of macros, and the outright omission of Outlook, is a critical issue for many businesses.
Business use leads onto the final Windows RT issue. Windows RT doesn't enable Windows 8 Pro features such as domain joining (though it can be administered using tools such as Intune). And the version of Office it ships with isn't licensed for business use. Business customers wanting to use Windows RT can do so, but they need to get a companion device license. This license doesn't change any software features; it just authorizes corporate use of the Office apps.
It's not altogether surprising that this range of features hasn't set the world on fire. The size, weight, and battery life of Windows RT devices is well matched by Atom-powered x86 devices—and x86 devices don't have any of the restrictions that ARM ones do. They can run desktop apps. And they cost about the same too. Sure, you'll have to buy Office as an extra, if you need it. But it'll be full Office. With macros. And Outlook.
As currently conceived, Windows RT is a lemon, and users are avoiding it in droves.
But I'm not sure it has to be that way. With a few small changes, Windows RT could make sense, just perhaps not the way Microsoft intended.
Although I've argued on these pages that Microsoft should provide an official method for installing arbitrary apps, including desktop apps, on Windows RT, I think it's clear that there are some markets where the lock down isn't a hindrance, but rather a feature. Corporate desktops and kiosk machines, for example, can both make good use of these restrictions—often they're the kind of restrictions that administrators will impose anyway.
The problem is that the licensing conditions surrounding Windows RT make it an unpalatable product for these very markets. This is a problem that Microsoft could very easily fix. Those corporate usage companion licenses should do more than merely permit Office RT to be used for work. They should unlock domain joining, they should unlock macroing, and perhaps most significantly of all, they should include an Outlook license. There are already rumors that Microsoft is testing an Outlook for Windows RT. This lynchpin of the corporate world should be made official.
I believe this change should, from a technical perspective, be reasonably easy for Microsoft to implement. Macros might be a sticking point, as there are complexities with porting the macro virtual machine to a new architecture, but I'm told that the work has all been done—the decision to not enable macros in the shipping product was done to prevent them from being used to write apps.
With this, Windows RT would become a viable working platform that was tightly locked down, and that could run on relatively cheap, robust, no-moving-part devices.
This would increase Windows RT's value on tablets and similar machines to an extent for corporate users, but I think Microsoft could then go a stage further: embrace Windows RT in non-tablet usage scenarios. Dell's Project Ophelia—an experimental system that puts an Android system on something about the size of a big USB key—is the kind of thing I have in mind. Build boxes maybe the size of a smartphone folded in half, perhaps even smaller, pack them with an ARM processor, 32 GB of flash, a DVI or HDMI port, an Ethernet port and/or Wi-Fi, and a couple of USB ports. For power, they could use a wall-wart. Electricity delivery using Mobile High-Definition Link (MHL) over HDMI would be even more appealing, as they could then be powered directly by a monitor, but it may not be able to deliver quite enough power.
Such (hypothetical) systems would be cheap. Without a built-in screen or battery, you'd be looking at $100 in materials, if that. It would be cheap to run, cutting HVAC costs. It would be robust. No moving parts, nothing to tamper with or go wrong, tolerant of dust, dirt, and vibrations. It would be more than powerful enough for many common desk-bound office tasks. And it'd be tightly locked down, not to mention straight up incompatible with common malware.
For legacy applications, the solution would be to either rebuild them as Metro/WinRT apps, or to use remote desktop to run them on some kind of VDI infrastructure.
Obviously, these solutions wouldn't work well for every organization. I wouldn't pretend that this market would be as sexy as the tablet market, either, and it won't make as much money as Apple makes from the iPad. Microsoft still has a consumer tablet problem that needs a solution. But for the typical office worker this kind of machine would be a neat fit. They'd work well for kiosks and other shared computers, too. The technology all exists today; it just requires Microsoft to change the way Windows RT is sold. With this change, a change that makes Windows RT's current weaknesses into virtues, Microsoft might just have a chance of making some lemonade.


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STP/Archive/Old STP Wiki
Welcome to the SOA Tools Platform (STP) Wiki! This collaborative workspace is here for us to thrash out ideas and concepts before putting the crystallized results on the STP website. Think of this as the conversation place, and the website as the group memory :-)
STP News
- The STP Wiki Landing Page is being updated - you can see what's going on at The New Landing Page, items that have moved will be scratched from here and you can go to the new page to find them.
- STP now accessed via subversion(SVN), the old CVS repository has been locked, and only allow browsing, all new code has been commit to SVN
Anonymous access: http://dev.eclipse.org/svnroot/stp or svn://dev.eclipse.org/svnroot/stp Committer access: svn+ssh://dev.eclipse.org/svnroot/stp Browsing: http://dev.eclipse.org/viewsvn/index.cgi/?root=STP_SVN
SVN HowTo: http://wiki.eclipse.org/SVN_Howto SVN book: http://svnbook.red-bean.com/
STP/Orbit Queue
- STP/TestPage
STP/Ganymede Release
STP Post-Europa - Plans and Contributions
- STP Intermediate Metamodel
- STP Incubator Subproject
- STP Planning Meetings
- SCA Composite Editor
- Cimero 2
- Migration to SVN
- Policy_Framework_in_STP
- STP Validation Framework
General Materials
- STP Meetup Eclipse Summit 2007 Ludwigsburg
- STP Logos
- STP Build 101
- STP Build Process and Procedures
- STP Build Using Buckminster
- STP Website Development
- STP Deployment Framework Requirements
- STP Targetted Runtimes
- STP Call for Scenarios
- STP Component Catalog
- Sybase Deployment Framework
STP/IM_Component/STP Internal Model Discussion
Discussion on STP_IM and JWT
STP/IM_Component/Sample scenario involving the intermediate meta-model
- STP Service Creation getting started guide for stp 0.7
- Getting started for new committer
- STP Usability Week
- STP Service Creation User Guide
- OSGI component support in Service Creation


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That distaste never abated, and I have felt ever since that the Court would be best served by inserting itself into campaign finance debates with less frequency.The Court would be best served, eh? The questions have to do with what the Constitution says about freedom of speech, so one must wonder why he'd think in terms of what serves the Court best as opposed to what the Constitution means or at least what serves the people best.
That view may have had an impact on the unusually long dissent that I wrote during my last term on the Court against the Court's overreaching in the Citizens United case...
In addition to my overriding hostile reaction to the subjects discussed in Buckley, I also recall puzzlement about why the Court failed to endorse the position expressed by Justice White in his dissent. He effectively explained why the distinction between limitations on contributions (which the Court upheld) and the limitations on expenditures (which the Court invalidated) did not make much sense, and why the Court should have respected the congressional judgment that effective campaigns could be conducted within the limits established by the statute. Time has vindicated his prediction that without "limits on total expenditures, campaign costs will inevitably and endlessly escalate." He thought it quite proper for Congress to limit the amount of money that a candidate or his family could spend on a campaign in order "to discourage any notion that the outcome of elections is primarily a function of money."That is, he favors limiting speech so that people don't get the wrong idea (the wrong idea being that money affects elections). Under the system we have, as the majority of the Supreme Court has interpreted the Constitution, candidates can spend all the money they want trying to get elected and people are free to get the "notion" that money affects the outcome of elections.
Justice Stevens continues:
The majority's response to Justice White relied on the rhetorical flourish that "the concept that government may restrict the speech of some elements of our society in order to enhance the relative voice of others is wholly foreign to the First Amendment." The assumption underlying that colorful argument...Colorful?
... is that limitations on the quantity of speech in public debates are just as obnoxious as limitations on the content of what a speaker has to say.That is to say, it's not really so bad for the government to tell a candidate: We think you've said enough.
But there is nothing even arguably unfair about evenhanded rules that limit the amount of speech that can be voiced in certain times or places or by certain means, such as sound trucks. If we view an election as a species of debate between two adversaries, equalizing the amount of time (or money) that each can spend in an attempt to persuade the decision-makers is fully consistent with the First Amendment. Otherwise, appellate court rules limiting the time that the adversaries spend in oral arguments would be invalid because they limit the speech of one adversary in order to enhance the relative voice of his or her opponent.He's equating the formal conditions within the confines of the appellate courtroom to the speech that takes place in the entirety of all of the forums in which a candidate might speak: all of the city squares and auditoriums, all of the TV and radio channels, all of the print media, and the entirety of the internet!
There's very little mention of Citizens United in Stevens's book, perhaps because the opinion wasn't written by the Chief Justice, and the subject of the book is Chief Justices. But he does mention it, musing that, based on Roberts opinion in Snyder v. Phelps, "perhaps I should give him a passing grade in First Amendment law."
But for reasons that it took me ninety pages to explain in my dissent in the Citizens United campaign finance case, his decision to join the majority in that case prevents me from doing so.That's it. He doesn't even attempt to explain Citizens United to the general reader, who's expected to accept that the Court got it wrong but it would take 90 pages to explain why. Citizens United — which we covered in my conlaw class yesterday — is indeed damned pesky to absorb, and there's something disturbing about a case that purports to tell us something fundamental about political speech in our democracy, but that cannot be talked about in straightforward terms. If he's so right and the other side is so wrong, he should be able to say why in a clear, readable few pages. Instead, what we get is either way overcomplicated, so you'll have to go read 90 pages, or it's insultingly oversimplified: John Roberts flunks!
Here's the 90-page dissenting opinion, in case you're up for reading it. As we say on the limitless internet: Read the whole thing. I'll bet very few people have read the whole thing. Justice Stevens delves into the history of Americans' attitudes about corporations. (In Citizens United, the majority emphasized free speech, not the source of the speech, while the dissenters made a distinction between individuals and corporations and would have accepted limits on speech when it comes from corporations.) Stevens wrote about the fear of corporations in early American history. He quotes Lawrence Friedman's "A History of American Law": "The word 'soulless' constantly recurs in debates over corporations… . Corporations, it was feared, could concentrate the worst urges of whole groups of men"). Later in his opinion, Stevens augments that anxiety about corporations with his own words: "corporations have no consciences, no beliefs, no feelings, no thoughts, no desires."
Here's the whole "soulless" paragraph from Professor Friedman's book:
The word "soulless" constantly recurs in debates over corporations. Everyone knew that corporations were really run by human beings. Yet, the word was not completely inappropriate. Corporations did not die, and there was no real limit to their size, or their greed. Corporations might aggregate the worst urges of whole groups of men. No considerations of family, friendship, or morality, would temper their powers. People hated and distrusted corporations, the way some people came to fear the soulless computer—machines that can join together the wit, skill, power, and malevolence of infinite numbers of minds.Thank God my computer is soulless! I'm using it to write this post, and I wouldn't like it to insert any morality, beliefs, feelings, thoughts, and desires, between me and you, as I invite you to aggregate your possibly evil urges here in the comments. With the power of the soulless computer we can join together the wit, skill, power, and malevolence of infinite numbers of minds.
How scary is that?


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Up and Down
The first three words I ever heard spoken by Steph Davis were yelled at the top of her lungs.ONE, TWO, THREE!She flew off the top of the Tombstone, ...
The first three words I ever heard spoken by Steph Davis were yelled at the top of her lungs.
She flew off the top of the Tombstone, a tower in Utah, and accelerated toward the ground. Her chute deployed, cracking thunder off the red sandstone walls. She floated down to the road, narrowly missing being hit by a car. After gathering her chute, she walked up with her arm extended.
"Hi, you must be Keith. I'm Steph."
The last few years for Davis have been up and down, in more ways than one. She redpointed the Utah crack climb Conception (5.13b), and free soloed Pervertical Sanctuary (5.10c) on the Diamond face of Long's Peak.
In 2006, Davis—who supports herself through sponsorships and speaking engagements—and her husband Dean Potter both lost their largest sponsors after Potter soloed Delicate Arch, tacitly understood as "off limits" to climbing, in Arches National Park. The resultant furor over what some called a media stunt damaged both climbers' reputations.
In July 2007, the Moab resident went skydiving for the first time. By October, she was BASE jumping, and by December, wingsuit BASE jumping.
This spring, Davis combined both her passions when she free soloed the North Face (5.11a) of Castleton Tower, and jumped off the top.
"You can get hurt really fast BASE jumping," she says. "But the more skill you have, the more chance you have. Soloing is more committing in some ways … mentally, it takes a lot."
Out at the crags, Davis is upbeat and always laughing. You have to wonder if all the negative press—not to mention the anonymous Internet comments, such as those criticizing her solo of Pervertical because she pre-placed tick marks—of recent years affects her, or if she is as stoic as she appears.
"I haven't had much to say about the Delicate Arch stuff," she says, "except that I learned a lot from it. I didn't understand how image could affect an athlete. I was deeply hurt and disappointed by the whole thing.
"I don't like to criticize anyone, because I've made a lot of mistakes in my life. Usually, negativity comes from unhappiness. Happy people wish good things for others. The best thing to do if people throw that energy at you is to wish them well, and hope they can be happier. Community is a huge part of climbing and jumping for me."


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Anderson Cooper talks to Dr. Drew and Dr. Gupta about the dangers behind combining medications and alcohol.
Post by: Anderson Cooper
Filed under: Medical News • Whitney Houston
Alcohol by itself has caused many deaths...statistics back that up....in this case it seems also have paid a major role....doctors have little or no control over that....no prescription required! Blame the doctors as enablers if you wish....but don't forget the bartender. Unfortunately drinking is where it all starts in many cases ...and sadly where it ends....she might have lived without it ...that is the sad part
I take Hydrocodone 10 mg four times a day for my chronic pain from fibromyalgia, but lately I have been cutting them in half to lower the dose. I also am prescribed flexeril s needed for muscle pain and I take a carvedilol for my heart. I have central sleep apnea, so I know better than to take a muscle relaxant or hydrocodone at night because I will cease to breathe. Hydrocodone paralyzes the muscles responsible for breathing and with central sleep apnea, the brain forgets to send the signal to breathe when I am asleep, so I take great care to stay alive, it's just that simple. RIP Whitney, I wish you were still here. xx
I LOVED, LOVED, LOVED this conversation. Please have more about the pharmaceutical abuse. Did anyone watch Torchwood last season? It's eerily similiar...
I don't think it's right to hold Whitney Houston's family & friends responsible for not doing enough to save her. I believe that lack of awareness is the real culprit here.. Generally, people tend to believe what they see & when her friends saw her "looking" happy & not appearing out of control or falling down drunk they assumed she was fine. They just didn't understand the disease of addiction. Thanks Anderson for the in depth coverage & expert guests educating us on the subject of addiction. These kind of conversations can save lives...
If at all, any of the media footage is accurate, regarding her turning flips, super hyper...just being an addict within its' self..should have been warning sings...quote un quote...You dont put a a Crack head at a table full of crack it's tempting..they will fall..This has hurt me deeply about Whitney....We as family & friends we often enable our love ones, being in denial...The time has come WE must stop....before it's too late
I'm sorry I spelled Dr Gupta name wrong. It should be corrected and I don't know how after posting message.
Harold H.
Anderson I watched with interest your interview with Dr Drew and Dr Dupta....The part in the interview that gave me great pause was when you talked about your use of a medical perscription drug and you stated that you had consumed some wine and Dr Drew got all over you for that...as I watched he was deadly serious, so serious that it even caught me by suprise, as it did you!...then Dr Dupta explained what happens in the brain when you mess with these combinations...they even suggested that only two drinks could have serious results....what a very eye opening interview.....this should be repeated to the publiic again we havent gotten serious enough about medication and drinking....thanks for this story.
Anderson Cooper goes beyond the headlines to tell stories from many points of view, so you can make up your own mind about the news. Tune in weeknights at 8 and 10 ET on CNN.
Questions or comments? Send an email
Want to know more? Go behind the scenes with AC361°


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John Darley on "Justice as Intuitions" – Video
Posted by The Situationist Staff on January 3, 2009
At the 2007 Project on Law and Mind Sciences Conference, John Darley's talk was titled "Justice as Intuitions." Here is the abstract for his talk.
When a person receives a description of an individual committing a specific crime, the person rapidly forms judgments on the severity of the offense and the duration of appropriate punishment for it. Evidence is converging that those judgments are what we would now call "intuitive" judgments. Rather than being the result of a reason-guided, step-by-step analysis, the severity and punishment judgments seem simply to "pop into" the heads of the respondents. Thus, they are similar to the heuristics, biases, and other shortcut decisions that we all use, as documented by the judgment and decision-making researchers. Imaging
research suggests that these intuitions draw on both evaluative and emotional areas of the brain. Behavioral research demonstrates that these intuitions are driven by intuitive ideas of "just deserts" (i.e., retributive reactions rather than more reason-based deterrent or incapacitive considerations). The high degree of consensus within cultures on these judgments
suggests that they are learned through early socialization processes, perhaps building on evolutionarily prepared cognitive structures.
* * *
This "justice as intuitions" account has several implications for the judicial system. Most disturbingly, evidence demonstrates that legal codes that contradict these culturally shared intuitions will move citizens toward moral contempt for the justice system and lessened willingness to voluntarily "obey the law." Rule-of-law practices need reconsideration in the light of an understanding of the basic shared notions within the population about right and wrong. Finally, we will examine how such actions as "insider trading" can be framed so that citizens will find them appropriately criminalized, and why some public welfare offenses are difficult to intuit as crimes.
Below you can watch a video of Darley's fascinating presentation (26 minutes).
Vodpod videos no longer available.
For related Situationist posts, see "Why We Punish," "Kevin Jon Heller on The Cognitive Psychology of Mens Rea," and "First Conference on Law and Mind Sciences."
To watch similar videos, visit the video libraries on the Project on Law and Mind Sciences website (here).
For information on the Third PLMS conference (scheduled for March 7, 2009), click here.
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This entry was posted on January 3, 2009 at 12:01 am and is filed under Abstracts, Emotions, Law, Legal Theory, Morality, Neuroscience, Social Psychology, Video. Tagged: intuitions, John Darley, Project on Law and Mind Sciences, punishment. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
One Response to "John Darley on "Justice as Intuitions" – Video"
August 14, 2010 at 1:22 am
[…] Revenge and Forgiveness," "Steven Pinker Speaks at Harvard Law School," "John Darley on "Justice as Intuitions" – Video," "The Situation of Punishment (and Forgiveness)," "The Situation […]


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Hello and welcome to another challenge at Winter Wonderland - Kate here.
Thanks so much to those of you that joined in with last weeks challenge. We really appreciate you preparing for Christmas with us. Don't forget to check back on Sunday for the winner and top 3.
Now onto this week's challenge which is
Photo Inspirational
and here is your Photo
Please remember Christmas projects only.We are sponsored by
Who are offering the lucky winner a £10 voucher
Here's the inspiration from the DT. We always appreciate a visit so if you click the name you can hop over and leave them a comment and also find out if they have combined their challenge with any others, which could give you some ideas.
I was inspired by the snowman and the snow and the red in the window and the red scarf.
Inspired by the window and the little one asleep in bed.
I was inspired by the window and the snow
I was inspired by the snowman and warm rustic colours
I was inspired by the colours and the little one tucked up in bed
Fabulous as always girls x
We all hope you are able to join us in our challenge this week. We look forward to visiting your blogs and seeing your gorgeous creations! Please be sure to post a link back to the Winter Wonderland blog in your blog post in order to be eligible for this weeks prize! Thursday evening () is the deadline for your creation to qualify for the prizes!.
So all that's left is for you to get creative and leave your entry here with the blue frog so we can come and find you asap.
Have fun and remember you can enter each challenge up to 3 times.


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Today, 2.1 billion people in urban areas use non-sewered (or on-site) sanitation facilities. While much of the work in rural areas is focused on creating and sustaining open defecation free communities and generating demand for communities to construct toilets, the downstream activities of collecting and transporting fecal sludge present a unique challenge for urban residents. These services are mostly provided by private operators, and are generally uncontrolled and unregulated. The inadequate disposal of fecal sludge in the environment represents a direct threat to public health and negates the positive outcomes from behavioral change and improvements in sanitation access.
The urban population in developing countries, and in particular the poor, rely on fecal sludge collection and transportation services that are often not affordable. In addition, pit emptying is often done by hand, exposing the operators to serious health risks (see figure below). Often mechanical emptiers, using vacuum trucks, charge excessive fees to customers but do not pay taxes or comply with laws and standards due to a general lack of regulation for these services. This makes it a highly profitable business. For example an emptying service provider in Abuja makes US$ 15,000 per month.
To better understand the markets for these services, the Bill & Melinda Gates Foundation funded a study [1] that analyzes the fecal sludge management sector and its operating models in 30 cities in Asia and Africa. The cities studied had populations of 100,000 – 5 million.
The study surveyed 13,000 households and 150 fecal sludge emptying and transportation service providers. The population of the 30 cities selected represents over 67 million people or 12 million households, providing a relatively comprehensive picture of urban sanitation services across ten countries.
The baseline information and findings of the study will be shared with sector stakeholders to help build sustainable service provision for sanitation and formulate policy recommendations to improve business sustainability.
The recommendations of the study addressed various issues faced by service providers in FSM and in particular how to improve profitability by proposing a more adequate business model, as well as measures to create an enabling environment for these services (as illustrated in the chart below).
The study also recommends the use of innovative solutions such as using geo tubes to create sludge transfer stations, which will reduce costs and increase the number of trips per day (which creates more profit for the operators and serves additional households). Geo tubes are containers made of permeable textiles used for dewatering sludge and sediment (see picture below). This solution has worked well in Malaysia, where the utility placed geo tubes in several strategic locations, resulting in a reduction of overall operations expenses by 37% and an increase of 35% in revenues.
The study also focused on other issues relating to the sanitation value chain, particularly the safe disposal and treatment of sludge. Wastewater treatment plants – if they exist – are in many cases inadequate for the size of the cities they serve, and fecal sludge treatment sites are scarce or inexistent. Safe re-use of human waste is also a sector that needs to be further developed, as it offers opportunities to create income-generating activities and produce bio energy.
By Pascal B. Garde, Consultant, WASH Policy and Governance, @GardePascal
[1] Chowdhry, S. and Kone, D., 2012. Business analysis of fecal sludge management : emptying and transportation services in Africa and Asia.
Available at: <http://www.washdoc.info/docsearch/title/179741>
Data on the expenditure on capital maintenance from this study have been used to calculate the cost benchmarks for basic sanitation service levels in the WASHCost project.
Related web site: Bill & Melinda Gates Foundation – Water, Sanitation & Hygiene


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In a bid to take on Amazon and other giants of public cloud infrastructure, Microsoft announced on April 16 that it has launched its own Infrastructure-as-a-Service (IaaS) offering as part of Windows Azure. Stepping beyond Microsoft's Platform-as-a-Service offerings, the new expanded Azure cloud service will allow users to deploy full virtual machines in Microsoft's cloud—including Linux instances.
The offering, which has been in limited release with companies such as the marketing and media firm Digital Air Strike, signals that Microsoft feels it is ready to take on Amazon. Bill Hilf, Microsoft General Manager for the Windows Azure team, wrote in a blog post that Digital Air Strike had been considering using Amazon Web Services before signing on for the Azure IaaS trial. "But [they] concluded that 'when you work for the enterprise, you have to choose Microsoft.'" Hilf added that Microsoft will also match Amazon's pricing on virtual machines and would provide "monthly SLAs that are among the industry's highest."
Microsoft is offering a number of preverified server images running on Windows Server, including instances of Microsoft BizTalk Server 2013, Project Server 2013, System Center, SharePoint (2010 and later), and SQL Server (64-bit versions, 2008 and later). The image library available to customers also includes Ubuntu, CentOS, and SUSE Linux distributions.
Hilf has made inflammatory comments in the past about Linux and open source. In a 2007 blog post, he tried to clarify his comment that "the Free Software movement is dead" by saying that he saw Linux as both a competitor and something Microsoft needed to interoperate with. Now his group is looking to cash in on Linux by including it in Microsoft's cloud product line.


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GateHouse News Service New England Budget • June 29, 2007
Here are the top New England regional stories from GateHouse News Servic
Contact: Chris Biondi, (508) 626-4343, firstname.lastname@example.com
Again, some of this stuff is live at www.gatehousenewsservice.com along with lots of other copy and photos. No word yet on wire service launch. I will post whatever I receive. Contact editors directly if you don't see it on the wire.
FOR SAT: ARMY RATIONS -- We get a tour of Natick Labs and a taste test of some new Army offerings.
MetroWest, Parietti, 15 inches, 6 p.m.
With photos
FOR SAT: TRAVELING THIEVES -- Traveling thieves have traveled up the east coast, stealing cameras and lap tops from Circuit Citys everywhere, with $50,000 to $60,000 worth of stuff. Natick was hit repeatedly in the past month. Police pick up on it and work with the Circuit City in Natick and almost catch them on Saturday. They're gone, but could be back.
MetroWest, Miller, 15 inches, 6 p.m.
With security camera shots
FOR SAT: DRUNKEN DRIVING - Staties and a bunch of others hold a presser at MSPHQ Friday morning to warn as holiday looms.
MetroWest, Miller, 12 inches, 6 p.m.
With photos
FOR SAT: BEER MONEY – Freetown and Boston Beer, gets a $2.5M grant for sewer/water infrastructure improvements, which was an issue with the brewery siting the facility in the town.
Herald News, Jeff, 6 p.m.
FOR SAT: LIGHTNING STRIKES -- Lightning strikes Fall River house; chimney explodes leaving bricks all over resident's yard.
Herald News, Will, 6 p.m.
FOR SAT: SUBURBAN VIOLENCE -- A look at urban violence creeping into the suburbs, such as in Randolph, Mass., where a teen was shot dead in broad daylight this week.
Enterprise, Maureen with Ledger adds, 16 inches, 4 p.m. Friday filing
FOR SUN: GANG CULTURE -- A close-up look at Brockton's gang culture.
Enterprise, Maureen/Mike, 20 inches, Friday night file
With file photos
FOR SUN: FOOD PRICES -- Part of our series on rising food costs. Cost of breakfast going up, due to rising price of corn, wheat, milk and other commodities, according to U.S Dept. of Agriculture. Home-cooked meals and restaurants to be included/
Enterprise, Elaine, 25 inches, 4 p.m. Friday file
Photos in in Bridgewater and Taunton
FOR SUN - CASINO WATCH: Experts say there is a market of $1.5 billion in revenue out there for a southeastern Massachusetts casino to capture, much of it from people in northern New England.
Enterprise, Mike, Friday night file
FOR MON - FIREWORKS AND THE FOURTH: Few people using fireworks get arrested despite
annual warnings from safety experts about dangers. Cops arrest people who sell them, like guy picked up in Stoughton, but typically just seize fireworks from individuals caught with them and might summon person to court where they get a slap on the wrist.
Enterprise, Maria, 25 inches, 4 p.m. Friday filing
MASS. HEALTH INSURANCE -- Businesses are scrambling to comply with the state's groundbreaking law requiring them to offer health care to all employees beginning this weekend.
Patriot Ledger, Adams, 20 inches, on wire now
With photo
MAHONEY CARTOON – One Massachusetts youth violence
Patriot Ledger, on wire now
FOR SUN: RICK HOLMES COLUMN -- Fantasy and reality collide in the virtual world of Second Life.
MetroWest Daily News, 6 p.m.
FOR SUN: EDITORIAL: Bush and U.S. image -- An international poll shows that George Bush and his policies have poisoned the image of America abroad and, sadly, discredited American values.
MetroWest Daily News, 6 p.m.
FOR SUN: EDITORIAL: Mass pension funds -- Massachusetts legislators should help prevent underfunded and under-performing municipal pension funds from becoming a bigger burden on property taxpayers.
MetroWest Daily News, 6 p.m.


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Field of Study Transition
The Field of Study profiles have been updated and are now called Majors. Use a search option below to find what you need.
- Browse All Majors
Look through all the new major profiles.
- Search Majors
Search for a major by keyword or career cluster.